A. Field of Invention
This invention relates generally to methods and apparatuses related to dentistry and more specifically to methods and apparatuses related to the treatment of bruxism.
B. Description of the Related Art
Bruxism is commonly known as clenching, bracing, gnashing, and or grinding of one's teeth. Stress and tension are reported as major contributors in the etiology of this condition although many theories exist as to its cause.
The problem and dispute arises as to the cause of the rampant parafunctional habits and parafunctional muscular activity found in most human population. The prevalence of excessively worn dentitions (including primary teeth of young children) appears to indicate that there is excessive muscular activity that is over riding any natural “cuspid protected” scheme that nature has provided. The exact cause of such muscular over activity and tension is presently unknown, however the stress of daily life seems to be a big contributor along with ingested stimulants, both natural and manmade. The muscles of mastication work in conjunction with many other head and neck muscles to provide the needed jaw movements for eating, drinking, speaking, laughing, crying, and frowning—just to mention a few. Present day occlusal guards seem to be protecting the teeth but overworking the musculature of mastication and in turn affecting many other muscles in the head and neck.
There are many known devices that are used to treat Bruxism. Essentially, the present state of the art for occlusal guards is that they provide an interface of hard plastic that the teeth (controlled by the muscles, and at night time this control is involuntary and uninhibited especially during dreaming) can “skate” around on and supposedly provide some freedom for the excessive muscular activity. The problem is that the muscle activity may actually be increased and these appliances may be triggering and enhancing muscle over activity. There seems to be a familiarity or “stomping ground” or a muscle memory “sweet spot” or “planes” that encourage more habitual and parafunctional muscle activity.
The hard interface unfortunately creates an end point or familiar home for the muscle driven teeth to teeth match-up and subsequently the recurrence of these contacts becomes more comfortable than desirable. These types of brux guards do little if any to minimize muscle activity.
The cuspid discluding appliances utilize a hard contact for interfacing between the opposing dental arches. This contact, incline, or ramp, is used to restore, correct, manage, or create the “cuspid protected appliance” and they do just that. However there is little or no reduction of the muscle activity.
Another popular appliance known as the NTI (nocioceptive trigemeinal inhibition) utilizes a hard interface between opposing dental arches in the form of an anterior deprogramming device to supposedly reduce muscle activity. It is reported to reduce parafunctional muscular activity during sleep while also disengaging ones teeth. These guards are still bulky and obtrusive and are not recommended for any wear during waking hours.
Other appliances utilizing hard interfaces use different “group function” principles to dissipate or moderate the interocclusal forces from parafunctional muscular activity during sleep. Again, none of these appliances appreciably reduce the muscular activity.
Still other appliances, some of which are soft, attempt to interface the teeth to teeth contact during the parafunctional muscular activity, however they are designed as a soft interface between all the opposing posterior teeth resulting in a mere cushioning of the parafunctional activity. This is the case in the over the counter-home remedy “boil and bite” type of mouth guard. These appliances are bulky and do not fit comfortably. The excessive opening of the vertical dimension and interference with the free-way space is damaging to the temporal mandibular joint (TMJ or jaw joint). These devices encourage excessive muscular activity much like having chewing gum in one's mouth. Covering posterior teeth, whether with soft or hard material, will incite muscular activity and place undue stress on the jaw joint.
Besides the above mentioned shortcomings practically all occlusal guards require a commercial laboratory to be involved increasing the cost to the patient. Most are typically cumbersome and difficult to wear and hence many practitioners are reluctant to “sell” their patients a relatively costly device which they may not be able to regularly wear. The resulting potential for buyer's remorse is too high for most dental practitioners to enthusiastically encourage their patient base to accept. Upon merely seeing a model of a proposed, traditional type, occlusal guard, most patients immediately tend to deny their need for such treatment knowing all too well they will not be able to tolerate such a device.
Estimates indicate that more than 85% of the general adult population (potentially more if considering affected children) are experiencing signs and or symptoms of bruxism. Dental professionals can easily see and verify the damaging effects of this malady; however, the insidious nature of this condition is such that most patients are totally unaware of the problem. Daytime parafunctional habits are most often denied by patients simply because of the habitual nature of the process. Much like blinking where one has voluntary control over eyelid closure, daytime habits of clenching go completely unnoticed. Most patients have no realization of either daytime or nighttime bruxism. Rarely does a patient report to his dental practitioner that he has been clenching during sleep, yet many signs and symptoms are apparent to the observant practitioner.
Unfortunately, it is generally very difficult to convince patients that they have a bruxism problem.